Pneumatic reduction of intussusception: factors affecting outcome in Thailand.

Background: Pneumatic reduction has become a therapeutic method for intussusception instead of surgery. It is more successful than barium reduction, but it depends on how much the operator is familiar with the method and equipment. Objective: Determine success rate and recurrent rate of intussusception and factors affecting outcome of pneumatic reduction in Thailand. Materials and methods: Fifty-eight children with 73 numbers of intussusception who underwent pneumatic reduction at Songklanagarind Hospital, Thailand between January 2002 and March 2007 were retrospectively reviewed. Age, sex, clinical parameters, physical examination, imaging findings, and reduction technique were evaluated. Results: Overall success rate was 54 out of the 73 episodes and recurrent rate was 10 out of 58 patients with intussusception. Long duration of symptom, rectal bleeding, dehydration, and leukocytosis significantly affected poor outcome. Radiographic findings of gut obstruction and ascites as well as sonographic findings of thickened colonic wall, trapped fluid between intussusceptum and intussuscipien, and small bowel obstruction could also predict the poor outcome. Conclusion: Many factors from clinical presentation, plain radiographic, and sonographic findings affect poor outcome of pneumatic reduction. However, it can be performed unless peritonitis and sepsis/shock are present.

Controversies in the TNM staging system for colorectal cancer

the stages of many cancers including colorectal cancer. One advantage of the TNM staging system is that it is revised continuously by the American Joint Committee of Cancer (AJCC) and the International Union Against Cancer (UICC) based on new evidence as it becomes available. The system still has some deficiencies and is being continually tested for the relevance of any questionable practices. Partial modification or even the complete change of some definitions are to be expected as such revisions continue. The goal is to minimize doubt that could lead to inappropriate treatment in patients from either underestimation or overestimation of cancer stages.